'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

NHS England chief 'incensed' by media coverage of GPs

NHS England chief executive Sir David Nicholson has said he was ‘incensed’ by recent negative media coverage of GPs, particularly after they had taken a leadership position in the NHS.

In the strongly worded speech, Sir David took aim at the recent debate in the media in which GPs have been targeted as cause for rising pressure on A&E departments. But he did say that changes were needed to how primary care works and that ‘radical’ changes were needed in the NHS.

Sir David told the conference that the media blamed professionals arbitrarily for the NHS’s problems, but he was particularly incensed by the attacks on GPs. He said: ‘There is a sort of wheel that gets spun every so often, and on that wheel this week it is nurses. Let’s criticise nurses. Let’s have a go at the nursing profession. Let’s all attack what nurses do. Or it is spun another week and it’s general practitioners, let’s have a go at general practitioners. I should say that every week it is spun for managers but that’s another story all together. But I was particularly I think incensed about some of the coverage in relation to general practice.’

He added: ‘We are having one of the biggest reorganisations ever in the history of the NHS, the pressure is on and yet hundreds of general practitioners said that we will take a leadership position in the NHS, we are prepared to make that commitment to taking the NHS through some of its most difficult days. And all credit it seems to me to those people who did that, they’ve done a fantastic job taking it forward and I think we are only at the beginning of understanding what the contribution the general practice can make about for the NHS going forward.’

Sir David said there was need for change, however: ‘I am a massive fan of primary care but it doesn’t deliver for everybody, people’s needs everywhere.

‘We need to have a radical look at how primary care works. I know many CCG leaders and GPs want to have a radical look at how that works.

‘We also need to look at incentives: the tariff, the quality premium, the contract, all of that has to radically change. Those things we are committed to do. We are absolutely determined to do. That was why we were set up.’

In the same speech, Sir David painted a bleak picture of NHS finances for the future, indicating that not even the QIPP challenge would suffice.

He said: ‘We talked about QIPP a few years ago thinking there will be no growth for a few years. There was an assumption that things were going to turn around in a few years, well they haven’t, so we need to make a long term plan.’

NHS England needs to involve the public in setting out a long term strategy for the NHS, he added.

He said: ‘We need to make case for change and engage the whole population in a big conversation about these issues [which is free from] the tyranny of political cycles.’

The whole argument is spurious. Simplicity itself to define what is expected of a GP. How many patients should a GP see, how many hours should a GP work in a given day/ week that is safe for GPs and patients. How many appointments a year per thousand patients. Take that further for all doctors . Define qualifications of managers and their bonuses and hours as well.

If this piece can be taken as representative of what he said, the only thing that he has praised GPs for is taking on the "leadership role in the NHS"He does not make any recognition at all of the demands of the day job. Nor does he say we are doing it well, in fact he says we are not " delivering for everybody"I do not find anything about his speech reassuring.

I do despair of NHS management - How long has it taken the penny to drop of the clear causal realtionships:-that if you denigrate GP's in any way you undermine Public trust in the GP, if you undermine trust the public loose confidence in the GP Service,if they loose confidence in the service they attend AED for Health needs;Oh Wait answer my own question with the next step, If the public attend AED for routine health matters in increaseing numbers it COST MUCH MORE MONEY!

So the answer is HMG and NHS Mangement cannot afford FINANCIALLY to denigrate general practice, rather than they truely desire to change their opinion.

My future vison of the likely changes to be announced - a primary care facility without medical staff but all perfomers badged as "consultant " or "specialist", so we can expect a return to normal " bash the medic"

Goodlooking, mega intelligent; highly motivated- you can see why the public should hate us.